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If you’ve looked closely at the warning labels on the antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, you were probably startled to see that thoughts of suicide, a depression risk, can also be a risk of the very medication intended to treat it. Is this headline-grabbing side effect common or rare? And what about sexual side effects and other unpleasant possibilities?

“Fear of side effects should never prevent a patient from getting treatment for depression,” emphasizes psychiatrist Susan G. Kornstein, MD, a professor of psychiatry and obstetrics/gynecology and executive director of the Institute for Women's Health at Virginia Commonwealth University in Richmond. "Untreated depression causes much more distress and impairment in functioning, not to mention the risk of suicide." Many researchers also believe that untreated depression, even if it subsides, leaves you vulnerable to a relapse much sooner than you might experience with SSRI treatment.

“The most common SSRI side effects are nausea, insomnia, somnolence, weight gain, and sexual dysfunction,” says Dr. Kornstein. “It’s important to note that the incidence of certain side effects is not the same for all SSRIs. For example, weight gain is much more common with paroxetine than with other SSRIs. And a given patient may experience a particular side effect on one SSRI and not on another.”

Most symptoms appear within the first two weeks in most people. It’s important to note that you can also experience negative side effects if you suddenly stop taking antidepressants.

Certainly one of the most significant and troubling side effects is the possibility for increased depression symptoms and even suicidal tendencies in some people, especially in kids and teens being treated for depression. However, it is often hard to know whether this is a side effect of medication or caused by the severity of the depression. A U.S. Food and Drug Administration review found one study indicating that about 4 percent of young adults taking SSRIs had suicidal thoughts or attempts, twice the number of those not on an SSRI, while other studies showed no increase whatsoever in suicidal behavior.

Develop a Side Effect Management Plan

Call your doctor. “Patients should call their doctor when the side effects are particularly distressing or if they significantly interfere with their day-to-day functioning,” advises Kornstein. Certain side effects, such as ongoing nausea or thoughts of suicide, are obvious reasons to call your doctor for help, but any side effect, even one that seems rather personal (such as not being able to orgasm as quickly as usual), is worth bringing up with your healthcare team.

Be patient. “There are transient side effects such as nausea, diarrhea, insomnia, and sedation that may appear in the first week or two and then resolve,” says Kornstein. With your doctor’s advice, you might need to simply stick with your treatment plan for a while longer and try some practical strategies for coping in the meantime.

Change the timing of doses. Simple changes, such as taking medication after meals to counter stomach problems or before bed if sleepiness is a problem, could be all you need to do to minimize side effects.

Adopt a strategy for each side effect. Talk with your doctor for specific ideas that will work for you, but here are some ways to ease common side effects:

Nausea. Eat small meals more often or suck on hard candies. Staying hydrated can also help.

Weight gain. Try to be physically active (national recommendations are for at least 30 minutes of activity most days of the week) and eat a calorie-controlled diet. Work with a dietitian if you aren’t sure whether your diet is nutritious as this can help you stay on track with your weight goals.

Sexual side effects. Men might benefit from medications that fight erectile dysfunction, while women can use lubricants or other tools to make sex more comfortable. Side effects such as sexual dysfunction are temporary but can be distressing. Creative approaches to sexual intimacy can help you enjoy yourself and stay connected with your partner even while you continue antidepressant treatment. Consider sex therapy as a way to get some new ideas for sex.

Insomnia. Taking an additional antidepressant before bedtime or a sedative might help you sleep better, as can cutting back on caffeine and getting more exercise during the day.

Dry mouth. Stay hydrated and try chewing gum. You also will need to get regular dental checkups to make sure your mouth is healthy -- your dentist could have some other ideas for fighting dry mouth discomfort.

Anxiety. Try relaxation techniques and more exercise, or consider switching to a different medication.

Increased depression or thoughts of suicide. Do not try to cope with these on your own. Let your doctor know if your depression or thoughts of suicide become more frequent or worsen after you begin treatment. Children and teens taking SSRIs should be watched carefully for signs of suicidal thinking.

Dizziness. Some people, especially older adults, can experience changes in blood pressure as a result of these medications. Take time getting up from a sitting or lying position and avoid driving or using heavy equipment if you are coping with dizziness.

Increase your physical activity. Exercise can help you manage weight gain, anxiety, gastrointestinal effects, and changes in sleep patterns that could result from SSRIs.

Get counseling for depression. Regardless of the side effects that might be troubling you, most people taking antidepressants also benefit from therapy to help them cope with the challenges in their lives and recover from depression.

The most important thing to remember is that you should never stop taking your medication without your doctor’s supervision. Stopping suddenly can cause other negative side effects -- get your doctor’s advice about cutting down or switching to another medication.

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